Comparison of Electrosurgery versus Conventional Instrumentation (Scissors) during Hysteroscopic Resection of Intrauterine Adhesions in Infertile Patients Undergoing Embryo Transfer.

Background/objectives: To evaluate the impact of use of electrosurgery at the time of hysteroscopic resection of intrauterine adhesions on the need, if any, for repeat operative resection and embryo transfer outcomes in an infertile patient population.

Methods: Retrospective cohort study completed at a single academic center in which a total of 110 infertile patients underwent an operative hysteroscopic resection of intrauterine adhesions with (hot) or without (cold) the use of electrosurgery and subsequent embryo transfer between 2005 and 2019.

Results: A total of 85 patients underwent cold dissection, and 25 patients had hot dissection. There was no difference in the need for repeat hysteroscopy between groups (cold: n = 21 [24.71%], hot: n = 8 [32.00%]; adjusted relative risk [aRR]: 0.76, 95% confidence interval [CI]: 0.33-1.74), the number of repeat hysteroscopies performed in each group (cold: 1.52, hot: 1.50; aRR: 1.50, 95% CI: 0.37-6.05) and endometrial thickness prior to embryo transfer between groups (cold: 7.80 ± 2.42 mm, hot: 9.02 ± 5.54 mm; aRR: 1.13, 95% CI: 0.92-1.39). Lastly, there was no difference in implantation rate (RR 1.03, 95% CI 0.68-1.58), ongoing pregnancy rate (aRR 0.90, 95% CI 0.49-1.65) and live birth rate (aRR 1.00, 95% CI 0.52-1.89) at the time of first embryo transfer after adhesion resection.

Conclusion: The use of electrosurgery for surgical management of Asherman's syndrome in patients with infertility does not appear to have detrimental downstream effects on the need for repeat hysteroscopic adhesiolysis, endometrial thickness, or in vitro fertilization embryo transfer outcomes when compared to cold hysteroscopic adhesiolysis.